Native tissue is superior to vaginal mesh for prolapse repair, two studies report

From UNC at Chapel Hill: The use of mesh for anterior prolapse is associated with long-term increased risk of any repeat surgery—especially mesh-removal surgery. From the Mayo Clinic: Natural tissue repair should be the procedure of choice for most women undergoing vaginal prolapse repair.

Michele Jonsson Funk, PhD, and colleagues from University of North Carolina (UNC) at Chapel Hill concluded that using vaginal mesh versus native tissue for anterior prolapse repair is associated with 5-year increased risk of any repeat surgery, especially surgery for mesh removal.1

Investigators from the Gillings School of Global Public Health at UNC studied health-care claims from 2005 to 2010. They identified women who, after undergoing anterior wall prolapse repair, experienced repeat surgery for recurrent prolapse or mesh removal. Of the initial 27,809 anterior prolapse surgeries, 6,871 (24.7%) included the use of vaginal mesh.1

the 5-year cumulative risk of any repeat surgery was significantly higher with the use of vaginal mesh than with the use of native tissue (15.2% vs 9.8%, respectively; P <.0001 with a risk of mesh revision or removal>

Dr. Jonsson Funk presented the study conclusions at the 33rd Annual Meeting of the American Urogynecologic Society in October 2012; their study was published online ahead of print on February 12, 2013 in International Urogynecology Journal.1

Mayo Clinic study details

Researchers from Female Pelvic Medicine and Reconstructive Surgery, Division of Gynecologic Surgery at Mayo Clinic reviewed the literature and compared vaginal native tissue repair with vaginal mesh–augmented repair of pelvic organ prolapse. Their report was published online ahead of print on January 17, 2013, in Current Bladder Dysfunction Reports.

The authors discuss POP; the procedures available to treat symptomatic POP; the Public Heath Notifications issued in 2008 and 2011 from U.S. Food and Drug Administration (FDA) regarding the use of transvaginal mesh in POP repair; and success, failure, and complication rates from both techniques.2

“Given the lack of robust and long-term data in these relatively new procedures for [mesh-augmentation] repair, we agree with the caution and prudence communication in the recent FDA warning,” state the authors.2 However, a caveat is offered that native tissue repair must utilize best principles of surgical technique and incorporate a multicompartment repair to achieve optimal outcome. The authors strongly advise that appropriate surgical technique, obtained only through adequate surgical training, can be improved for both repair procedures.2

Risks and complications from mesh. Mesh introduces unique risks related to the mesh itself, including mesh erosion, and complications, including new onset pain and dyspareunia following mesh-augmented repair. Complications are possibly related to the intrinsic properties of the mesh, (ie, shrinkage); to the patient (ie, scarring); or to the operative technique (ie, the placement/location of the mesh and increased tension on the mesh). The authors conclude that additional studies are needed, given the lack of robust and long-term data on mesh-augmentation repair of POP.2

“The evidence thus far has not shown that the benefits of mesh outweigh the added risks in vaginal prolapse repairs,” write the authors.2 Therefore, although patient-centered success rates for both techniques of POP repair are equivalent, the authors conclude: “there does not appear to be a clear advantage of mesh augmentation repair over native tissue in terms of anatomic success.”2